This year’s Hospital Guide – in both digital and printed formats – is delivered using posters. Why posters? In the era of electronic media, using one of the oldest forms of communication known to man may seem perverse. But there are good reasons why sticking information up on walls has remained popular, from ancient royal proclamations to modern marketing campaigns.
One of the most obvious features of posters is that they are, by their nature, public and transparent. Books and websites are made to be read individually and digested in private. Posters – digitally and in print – are about sharing information and messages.
Another reason is that they are concise. More than ever, in healthcare, we need to learn to boil information down into clear conclusions. We need to work hard to see the wood for the trees.
When Dr Foster first started publishing this guide more than a decade ago, we were addressing the lack of information about quality of healthcare. It was not just that the public had little or no information. Nobody inside or outside the NHS had the information they needed to tell good care from bad.
Today, for much of the NHS the problem is no longer a lack of information, it is a surfeit.
NHS hospitals are awash with data. Along with the information that Dr Foster provides, there are national reporting systems; national clinical audits; feedback from NHS Choices, from national patient surveys and from staff surveys; reports from patient safety monitoring programmes and from infection control monitoring… to name just some of the most obvious sources. Within the hospital there is an ever increasing pool of information drawn from internal information systems and electronic records. Each source is capable of providing information about different diagnoses, different patient groups as well as trends over time.
Put it all together and those running hospitals or commissioning NHS services have available to them tens of thousands of data points which relate to the cost and the quality of the service they provide. How does the board of a hospital make any decision comfortable in the knowledge that it has adequately assessed the available information?
The complexity leads some people to despair of the process. Observing that the data is of variable reliability, sometimes contradictory and never simple to interpret, they conclude that nothing can be proven beyond doubt and wash their hands of the whole exercise.
That is a cop out. Decisions about spending and care will be made one way or the other. We have seen too often the consequence of bad decisions – decisions made in the face of strong clues in the data that the actions being taken were causing harm to patients and wasting resources. The problem may be hard but it cannot be ignored or avoided.
Doctors understand this dilemma. The art and science of diagnosis requires the assessment of complex, sometimes contradictory clues to reach a view on the best way to treat the patient. Sometimes it is simple. Sometimes the only option is to proceed with treatment On the basis of uncertain conclusions on the grounds that doing nothing is likely to be worse.
The management and administration of our health services has yet to achieve an equivalent degree of skill in the way it uses information to diagnose the problems of our health system and identify the most appropriate remedies.
This may explain one of the most troubling findings in this year’s guide. This year we set out the findings of a survey of NHS hospital doctors carried out by Doctors.net.uk. Most doctors responding to the survey did not agree that their hospital always acted on concerns raised by staff. One in four expressed no confidence in the management of their hospital.
Less surprising was the finding from the survey that most doctors believe patients get a worse standard of care if they come dr foster hospital guide 2013 into hospital at a weekend. This year we have returned to the subject of hospital care at weekends and looked at a wide range of measures – mortality rates, readmission rates, access to diagnostic tests and the length of time that urgent patients wait for surgery. On every measure we looked at, the position for patients admitted at weekends was worse than for patients admitted during the week.
Each data point on its own is open to interpretation. Every number we publish is affected by confounding factors and surrounded with statistical uncertainty. No single metric could ever safely lead to a firm conclusion.
But when all the data points in one direction – when every piece of information is repeating a consistent message – it is important to draw that conclusion out clearly and share it. That is why we have used posters.
Whether it is the impact of drugs and alcohol on our health and on the NHS, the variation in mortality rates between hospitals or the way in which financial constraints are affecting services, our aim has been to draw out the important messages and provide a mechanism to communicate them.
The Hospital Guide is sent to every hospital and commissioning chief executive in England. We hope that within it they will find at least one poster that they would like to put up in their office or in the corridors of their hospital.
This does not mean, of course, that we are giving up on digital media. Here at myhospitalguide.com you can interrogate all the data in detail, link to the many examples of excellent practice highlighted in the guide, and share the report and posters with your own contacts to stimulate discussion and change. We hope that you will do that!
Co-founder, Dr Foster Intelligence